I waited with my brother at nuclear medicine among other patients, and unlike other doctors' offices, no one spoke. It was eerily quiet. Looking at the patients, I could not determine if they were people fighting cancer or like my brother trying to ascertain how much the cancer had spread.

Luckily for our family, his cancer has not spread to other organs. Now we wait to see if the tumor can be removed endoscopically or will he need surgery. Let's hope it is the former and not the later.

Most people do not understand enough medicine to fully comprehend what the troubling health news means.  

When you enter the nursing you can comprehend the diagnosis. This proves to be a double edge sword as you equate the diagnosis to morbidity and mortality.

Recently, my brother visited an orthopedic surgeon to examine some swelling in his foot. Due to an underlying neurological condition, neurofibromatosis, benign tumors form in many locations and in some instances are malignant. He never complains so when he does the family becomes concerned. 

It turns out the foot is fine; the swelling was due to a soft tissue injury. However, he mentioned trouble swallowing and he found eating difficult. So we scheduled an upper endoscopy. They found a mass which they took biopsy for pathology. The pathology revealed some troubling news that the mass was malignant.

My brother to my amazement takes it in stride. Never does he fade into sadness nor does he withdraw into his own world. He seems ready to fight this and so will our family.

I recently received something far greater than any gratitude or 'atta boy' I had received from a superior during my days in business.

A patient called our manager to say that I and a colleague provided great care and our actions are what makes our unit so great. My manager wrote me an encouraging note and congratulated me for my good work. That made my week.

During these tough economic times we cannot expect financial rewards, so these notes mean so much to many people. They can provide tremendous motivation to nurses.

Well, my wishes went unheeded. Not only did I need to care for patients post-procedure, but many times nurses and doctors asked for assistance in procedure rooms with getting supplies or running samples to the labs for testing. The morning moved into early afternoon and the work pace and my heart rate never decreased. My mind raced with numerous key-minute details regarding my patients' condition and the respective steps required for their discharge.

"The patient in 1 needs anesthesia to sign them out, 2 needs pain reassessed after I return from the blood bank and pathology lab," I said to myself as I race-walked back to the unit. If Barak Obama or Cole Hamels asked, "Where is the ER?" I would just give them directions without recognizing their respective celebrity status. I was too focused on getting back to these patients.

When lunchtime arrived, I quickly ran out of the unit. I felt beat up, sore and wondered what the afternoon would bring to add to this tough day. Walking down the hall, I heard a child's cry. When I looked up I saw a crib being wheeled into an operating room suite. This visual changed my whole perspective. We do not see many children patients at our hospital so I would expect this child must be very ill or requires a unique surgery unavailable at CHOP or Saint Chris's.

As the crib left my visual field, my heart sank and I quickly forgot the dread I felt from my unit's patients. Even after leaving school and working almost a year, the site of an ill child still brings my mind to a standstill. I walked past the operating suite and did not look in or up hoping that I would not see the parents or relatives. After lunch, I returned to the unit more refreshed and with a different outlook.  

I placed the constrictor mid forearm and began my search for a suitable vein in the hand. Finding one, I pierced the patient's skin and subsequently the vein. Quickly I threaded the catheter removed the constrictor and secured the IV access. After a thorough assessment, I determined the catheter was placed correctly. Thanking the patient I removed my gloves and washed my hands wondering which patient was next.

As a healthcare professional, I feel that perhaps that I might lose some perspective of the patient's point of view. Every day I come to work wondering which patients the charge nurse  will assign me. For me, this is my job. It does not define me or serve as my identity.  

Do not consider these words indicating burnout or job dissatisfaction. I love what I do and still feel that I should have been a nurse but, I wonder if I show enough compassion care or concern for my patients with each new contact. Do I take the time to see things from a patient's eyes?

I thought I did since I once received anesthesia, waited in the ER for hours hoping the doctor would either admit me or send me home, received a scary diagnosis and surgery. With my prior experiences and family in the industry I did not experience the anxiety or concerns that patients without these resources may feel.

In order to remain empathetic and caring I feel I must remind myself that what I might consider trivial or inconsequential another may consider significant or stressful.

Later that day, I volunteered to let a med student place an IV in my hand. The student diligently followed aseptic technique and grabbed the needle. While I've placed hundreds of IVs and considered it routine, I found I was nervous and felt the pain of the needle piercing the skin feels more painful than a big pinch.

It is funny in a strange way that a little pain provides me with that reminder that I must always consider the feelings of the patient with any action or movement no matter how insignificant it may be to me as a nurse.

What an awful diagnosis, the jaundice skin revealed a glimpse into the disease's pathology. I could not imagine the pains this patient endured and will in the future. As the patient rested quietly, I sadly wondered who else would be impacted by the news. Secretly I hoped the patient would sleep a little longer peacefully. Time passed and the patient awoke without major complications other than pain.

Soon the patient received the news from the doctor and took the diagnosis incredibly well. No sobbing, yelling or other outbursts. Inside I wondered if the patient was in denial, suppressing the emotions until arriving home or would seek other avenues for support. The patient prepared to leave the unit I felt incredibly sad that this person did not have family or friends for the trip out of the hospital. As the curtain opened and the patient stepped out, I wondered if the patient stoic appearance was a result of bravery or shock.

We walked downstairs without exchanging any words or glances. I looked into the patient face trying to determine the patient's emotional status. After multiple checks and glimpses into the patient's face I could not determine anything. We found the person who would accompany the patient and I watched the patient walk off. Turning back into the hospital, I walked back to the unit and gathered my stuff to go home.

On my ride home, I spent a lot of time thinking about this patient. What plans would the family make? How would they all handle this terrible news? What would I do in this situation? I thought about it and realized that this was a fruitless and petty exercise. I did not receive a diagnosis such as pancreatic cancer today and hoped never would. Suppressing my tears and bottling my emotions I realized that I need to let these feelings go and move on. Other patients would receive terrible news and perhaps would not handle the news as well.     

  As many of you know, a lay off prompted my career switch to nursing. Since entering the field, I always felt that I should have made this switch ten years ago and saved myself from the stress associated with uncertainty in the business world. Even in good times, I was never sure if the next quarter would yield a change in corporate strategy or acquisition leading to another job loss.

I always thought that nursing would offer the employment stability that many in the corporate world crave in these uncertain times. Well, to my surprise, the economic contagion has infected health care. Our hospital has not mentioned layoffs or pay cuts however recent correspondence from administration left me and others with some concerns.

Currently departments with open positions will not fill them whether in environmental services or ultrasound or nursing. We nurses need to do more with less resources regardless of the patient volume. Meeting this challenge will require increased focus and  the need to find ways to eliminate waste. Waste, which includes resources and time. Nurses operate at the micro level in the healthcare system and witness all types of waste. We need to make suggestions to our managers that will increase efficiencies in patient care and ancillary or support steps.

In our department, we fill out so many forms and perhaps we need to examine these steps to see if any can be eliminated without increasing patient risk. Being new means that maybe we can offer a new perspective or observation to improve efficiency.
In order to accomplish these tasks, I feel management needs to provide an incentive to the staff. These incentives do not need to monetary, they could be time off, vacation requests, receive priority status or preference for work schedule.   

In the ER, luck allowed me to observe three codes. While some healthcare professionals find these moments more stressful than an IRS audit or losing a wallet, I found them adrenaline pumping events like I had the ball for the last shot to win the game. The awesome responsibility was someone else's, or in nursing terms, not my license. Today it was my license.

My luck, I was with the patient all day watching his vital signs change. In the beginning, he sounded like he had a bad cold. He wheezed on expiration and coughed numerous times. What troubled me was the cough did not produce that familiar mucus you expect.

Then as we prepare to discharge him, his sats drop and his heart rate goes tachy. Crap I say, what is next? I call an attending, describe his condition and vital signs. He asks for a rapid response, a step below a code, which we call.

Soon after the call, the team arrives and gets a brief description of the circumstances and they evaluate the patient. Following multidisciplinary consultations, they decided to give the patient some lasix to help his body get rid of extra fluid.

The lasix works and the patient is transferred to a monitored floor and I found out later he left the next day.

As my first critical event with my patient and with help from doctors, nurses and others, we treated the patient without the patient spiraling into a full code.

P.S. Mom is ok!

This week convinced me that things can turn so fast in nursing regardless of acuity levels.

After working 11 and half hours, I was looking forward to heading home. My patients were fine and preparing for a restful evening. Suddenly, I hear a call for help. I followed these calls where I found a doctor and nurse wrestling with a crying patient. As entered the room, the doctor asked me to call security because he found the patient preparing to commit suicide.

I contacted security and returned to the room to see if anyone required my assistance. Upon entering the room, my eyes met the patient's eyes. The look of despair and sadness burned into my memory that I doubt I will ever forget it.

The patient was dying, but without the story from the chart you would not know. There were no EKG monitors, SpO₂ or noninvasive BP giving you a clinical picture. The only clinical picture or prognosis you would receive came from the chart.

At this time, I do not know which is a tougher patient to deal with, one where the monitors tell you the story or the chart.